Healthcare Provider Details

I. General information

NPI: 1700843695
Provider Name (Legal Business Name): CHRISTOPHER JAY REYNOLDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 N 1100 E
AMERICAN FORK UT
84003-2952
US

IV. Provider business mailing address

52 N 1100 E
AMERICAN FORK UT
84003-2952
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-0901
  • Fax: 801-763-0903
Mailing address:
  • Phone: 801-763-0901
  • Fax: 801-763-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number173564-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number173564-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number7014A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: